Alternating Proprietor Licensed Premises Application {DR 8370}

Department use only DR 8370 (09/24/09) COLORADO DEPARTMENT OF REvENUE LIQUOR ENFORCEMENT DIVISION DENVER, CO 80261 (303) 205-2300 ALTERNATING PROPRIETOR LICENSED PREMISES APPLICATION NOTE: Only holders of alcoholic beverages licenses that authorize the manufacture of vinous liquors, malt liquors, and fermented malt beverages are eligible for this license. 1. Name of Applicant (host manufacturer) 2. Name of Tenant Manufacturer (only one per application) 1. Address of premise to be alternated City 4. Mailing Address (number and street) County City or Town State State ZIP ZIP 5. Is the Host applicant a federally licensed manufacturer of vinous liquor, malt liquor or fermented malt beverages? .............................. If so, federal permit # __________________________ (copy of basic permit must be attached) 6. Is the Host applicant licensed by the state as a manufacturer of vinous liquor, malt liquor or fermented malt beverages? .................... If so, state license # __________________________ (copy of state license must be attached) 7. Is the Tenant manufacturer a federally licensed manufacturer of vinous liquor, malt liquor or fermented malt beverages? .................... If so, federal permit # __________________________ (copy of basic permit must be attached) 8. Is the Tenant manufacturer licensed by the state as a manufacturer of vinous liquor, malt liquor or fermented malt beverages? ......... If so, state license # __________________________ (copy of state license must be attached) Please attach the following to this application: yes no yes no yes no yes no · Diagram showing the entire licensed premises with color-coded areas showing the areas designated as "Alternating Proprietor Licensed Premises" and the area to remain as "Dedicated Premises". · A written and executed Alternating Proprietor Agreement. · Completed questionnaire attachment to this application OATH OF APPLICANT I declare under penalty of perjury in the second degree that this application and all attachments are true, correct, and complete to the best of my knowledge. Authorized Signature Title Date DO NOT WRITE BELOW THIS LINE ALTERNATING PROPRIETOR LICENSED PREMISES Name of Manufacturer Colorado License Number The State may convert your check to a one time electronic banking transaction. Your bank account may be debited as early as the same day received by the State. If converted, your check will not be returned. If your check is rejected due to insufficient or uncollected funds, the Department of Revenue may collect the payment amount directly from your bank account electronically. Period $150.00 STATE 2285­100 (999) TOTAL AMOUNT DUE $150.00 American LegalNet, Inc. www.FormsWorkFlow.com DR 8370 (09/24/09) COLORADO DEPARTMENT OF REvENUE LIQUOR ENFORCEMENT DIVISION DENVER, CO 80261 (303) 205-2300 ATTACHMENT TO ALTERNATING PROPRIETOR LICENSED PREMISES APPLICATION This page must be completed and attached to your signed application form. Failure to include this page with the application may result in your license not being issued. Name of Applicant Operating Manager Business Address State License Number Business Phone Number 1. Time period of Tenant alteration _______________________________________________________________ __________________________________________________________________________________________ 2. What percentage of the square footage of the licensed premises will be made available to the tenant listed through alteration? ______________% 3. Will any of that area be a retail sales area? ...................................................................................... yes no 4. Do you currently have other tenant manufacturers engaged in manufacturing, bottling, or storage on the licensed premises? .......................................................................................................................................... yes no If so, please list ____________________________________________________________________________ 5. Will the tenant manufacture proposed in this application use any areas of the licensed premises that are currently occupied by other authorized tenant manufactures? .............................................................. yes no n/a 6. Explain how the tenant manufacture will identify those areas of the licensed premises that are intended for their possession and use (e.g. place cards, partitions)? __________________________________________________ __________________________________________________________________________________________ 7. Will the tenant manufacture use the services of your employees, or will they have their own employees on site? ........................................................................................................................... yes no 8. Will the tenant manufacture maintain title and control over raw materials intended for manufacture of their product? ............................................................................................................................................ yes no 9. How will the movement or transfer of raw materials within the alternating premises be recorded? _____________ __________________________________________________________________________________________ __________________________________________________________________________________________ 10. How will the various stages of manufacture within the alternating premises be recorded? __________________ __________________________________________________________________________________________ 11. Will the tenant manufacturer warehouse store it's finished alcohol beverage stock on the alternating premises? ..................................................................................................................... yes no If so, how will it be distinguished from your inventory? _______________________________________________ __________________________________________________________________________________________ Signature Printed Name Date American LegalNet, Inc. www.FormsWorkFlow.com